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Abstract: PO0848

Renin-Angiotensin-Aldosterone System Blocking Drugs in Patients with SARS-CoV-2: Systematic Review and Meta-Analysis

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Chu, Chang, Charité – Universitätsmedizin Berlin, Berlin, Germany
  • Zeng, Shufei, Charité – Universitätsmedizin Berlin, Berlin, Germany
  • Hasan, Ahmed A., Department of Nutritional Toxicology, Institute of Nutritional Science, University of Potsdam, Potsdam, Germany
  • Hocher, Carl-Friedrich, Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology), University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
  • Krämer, Bernhard K., Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology), University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
  • Hocher, Berthold, Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology), University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
Background

COVID-19 patients requiring treatment with blockers of the renin-angiotensin-aldosterone system (RAAS) are at highest risk of developing pneumonia and dying. ACE2 is the functional receptor for SARS-CoV-2. Animal studies suggest that RAAS blocking agents might increase the expression of ACE2 and hence potentially increase the risk of SARS-Cov-2 infection.

Methods

We conducted a systematic review and meta-analysis of published studies on the association of RASS blocking agents with lung disease related outcomes.

Results

The effect of ACE inhibitor treatment on the incidence of pneumonia in non-COVID-19 patients was analyzed in 25 studies (330,780 patients). ACE inhibitor use was associated with a 27% reduction of pneumonia risk (OR: 0.73, p<0.001). Pneumonia related death cases in ACE inhibitor treated non-COVID-19 patients were reduced by 27% (OR: 0.73, p=0.004). ARB treatment was analyzed in 10 studies (275,621 non-COVID-19 patients). The risk of pneumonia was not different between patients who did or did not use ARBs. Pooled result from 13 studies (27,704 COVID-19 patients) showed that COVID-19 related severe adverse clinical outcomes were not different between patients who did or did not use RAAS blocking agents (OR: 0.87, p=0.28). All-cause mortality risk in COVID-19 patients was reduced by 27% (p=0.04).

Conclusion

Given the weak evidence coming from animal studies and the clear beneficial data of ACE inhibition in non-COVID-19 patients and the limited but promising data in COVID-19 patients, the use of RAAS blocking agents in patients with SARS-CoV-2 infection is justified. Further clinical studies analysing ARBs and ACE inhibitors separately in COVID-19 patients are needed.